Peripheral Facial Palsy and Communicating Hydrocephalus as a Clinical Presentation of Hemorrhagic Vestibular Schwannoma: Case Report

Abstract

The vestibular schwannoma is the most common extra-axial tumor of the posterior fossa. Hemorrhage associated with vestibular schwannomas has been described in less than 1% of the cases. The etiology remains unknown; however, some risk factors have been suggested, such as tumor size and tumor growth rate, the vascularity and histopathology of the tumor or even previous treatment with radiosurgery. The present case is of a 74-year-old female patient, who presented to our clinic in December of 2015 after a mild traumatic brain injury. In that context, she did a brain computed tomography (CT) scan and was diagnosed with a vestibular schwannoma— an incidentaloma. It was decided at that time to treat the patient conservatively because of her comorbidities and the presentation of the disease. In March of 2017, the patient presented again to our clinic with a right peripheral facial paralysis (House-Brackmann [HB] grade IV-VI) and confusion. The CT scan revealed that bleeding around the vestibular schwannoma had caused the clinical presentation. We decided to treat the hydrocephalus with a ventriculoperitoneal shunt. At the time of her last follow-up visit, the confusion symptoms had resolved, and her right-sided facial function had improved to a HB grade II-VI.

Keywords

vestibular schwannoma - brain hemorrhage - hydrocephalus - peripheral facial paralysis

• References

• 1 Asari S, Katayama S, Itoh T, Tsuchida S, Furuta T, Ohmoto T. Neurinomas presenting as spontaneous intratumoral hemorrhage. Neurosurgery 1992; 31 (03) 406-411 , discussion 411–412
• 2 Paldor I, Chen AS, Kaye AH. Growth rate of vestibular schwannoma. J Clin Neurosci 2016; 32: 1-8
• 3 Benhaiem-Sigaux N, Ricolfi F, Torres-Díaz A, Keravel Y, Poirier J. Haemorrhagic acoustic neuroma with features of a vascular malformation. A case report. Neuroradiology 1999; 41 (10) 795-798
• 4 Carlson ML, Driscoll CL, Link MJ, Inwards CY, Neff BA, Beatty CW. A hemorrhagic vestibular schwannoma presenting with rapid neurologic decline: a case report. Laryngoscope 2010; 120 (Suppl. 04) S204
• 5 McCoyd K, Barron KD, Cassidy RJ. Acoustic neurinoma presenting as subarachnoid hemorrhage. Case report. J Neurosurg 1974; 41 (03) 391-393
• 6 Niknafs YS, Wang AC, Than KD, Etame AB, Thompson BG, Sullivan SE. Hemorrhagic vestibular schwannoma: review of the literature. World Neurosurg 2014; 82 (05) 751-756
• 7 Sughrue ME, Kaur R, Kane AJ. , et al. Intratumoral hemorrhage and fibrosis in vestibular schwannoma: a possible mechanism for hearing loss. J Neurosurg 2011; 114 (02) 386-393
• 8 Dehdashti AR, Kiehl TR, Guha A. Vestibular Schwannomas presenting with haemorrhage: clinical presentation and histopathological evaluation of an unusual entity. Br J Neurosurg 2009; 23 (04) 431-436
• 9 Kim SH, Youm JY, Song SH, Kim Y, Song KS. Vestibular schwannoma with repeated intratumoral hemorrhage. Clin Neurol Neurosurg 1998; 100 (01) 68-74
• 10 Ramina R, Aguiar P, Tatagiba M. Vestibular schwannomas: current state of the art. In: M. Samii's Essentials in Neurosurgery. Springer-Verlag Berlin Heidelberg; 2008: 175-184
• 11 Pollock BE, Lunsford LD, Flickinger JC, Clyde BL, Kondziolka D. Vestibular schwannoma management. Part I. Failed microsurgery and the role of delayed stereotactic radiosurgery. J Neurosurg 1998; 89 (06) 944-948
• 12 Pollock BE, Lunsford LD, Kondziolka D. , et al. Vestibular schwannoma management. Part II. Failed radiosurgery and the role of delayed microsurgery. J Neurosurg 1998; 89 (06) 949-955